Distinctive histopathologic findings in linear morphea (en coup de sabre) alopecia.

Linear morphea en coup de sabre is a localized form of morphea that presents as paramedian face or frontal scalp depression. The histopathology of alopecia in linear morphea is typically characterized by sclerosis and a reduction in the number of follicular units. We present a 26-year-old Caucasian female with a 1.5-year history of linear morphea and alopecia with unique atrophic follicular remnants on scalp biopsy. Transverse and vertical sections of biopsy specimens showed dense, dermal sclerosis with marked eccrine gland atrophy and replacement of much of the adipose by collagenous tissue. All sebaceous glands had disappeared, but erector pili muscles persisted. Numerous vertical, columnar and epithelial structures were present at the sites of formerly viable hair follicles. Transverse sections of these atrophic follicular remnants had a resemblance to telogen follicles but were microscopically different. The morphology of these follicular remnants indicates an end-stage process or permanent alopecia. Similar follicular remnants have been reported in chemotherapy-induced permanent alopecia but not in alopecia secondary to morphea or other cicatricial alopecias. We discuss the significance of these findings and their relationship to other forms of cicatricial or permanent alopecia based on the literature and case review.

A review of scalp camouflaging agents and prostheses for individuals with hair loss.

Hair loss is a common problem for both men and women and may impact negatively on self-esteem. A variety of medical and surgical treatment options are available depending on the type of alopecia. Many patients also seek the advice of their physicians about options to hide or reduce the appearance of hair loss with hair prostheses (wigs, hairpieces, and extensions) or hair camouflaging agents (hair fibers, powder cakes, lotions, sprays, hair crayons, and scalp tattooing). Herein, we review current methods to hide or reduce the appearance of hair loss and discuss their associated costs, advantages, and disadvantages. Knowledge of products available to cover scalp, eyebrow, and eyelash hair loss may not only better equip clinicians to respond to questions from concerned patients, but may provide additional options to help these patients best cope with their hair loss.

Perioral lesions in ectrodactyly, ectodermal dysplasia, clefting syndrome.

Ectrodactyly, ectodermal dysplasia, clefting syndrome (EEC) is a rare autosomal dominant genodermatosis. We describe perioral lesions presented in a young boy with a history of EEC. While this is not the first mention of perioral lesions in EEC, they have been poorly characterized and are not defined as a common feature of the syndrome.

High prevalence of unlabeled chronic kidney disease among inpatients at a tertiary-care hospital.

BACKGROUND: Although awareness of chronic kidney disease (CKD) is low in outpatient settings, the prevalence of unrecognized CKD in the inpatient setting is unknown. METHODS: We examined the extent of unlabeled CKD among adults admitted to a tertiary-care hospital in North Carolina, based upon a combination of web-based medical record review, chart review, ICD-9 codes and laboratory information from 2000 to 2005. RESULTS: A total of 9772 patients had 2 or more serum creatinine measures at least 6 months apart and demographic variables for race and sex; 431 met criteria for stage 5 CKD (estimated glomerular filtration rate<15 mL/min/1.73 m2) and 6851 patients had stage 2 to 4 CKD (estimated glomerular filtration rate between 15 and 89 mL/min/1.73 m2). Within the latter groups, 3002 had stage 3 to 4 CKD, and 3849 had stage 2 CKD. Forty-three percent were male, 37% had a minority race/ethnicity. The number of patients not labeled as having CKD by ICD-9 code was 2176 (72.5%). Women and whites were less likely than men and minorities to be labeled as having CKD by ICD-9 codes. Medical record review of 600 randomly selected patients identified 399 patients with stage 3 or 4 CKD diagnosis. ICD-9 codes had a sensitivity of 0.50, specificity of 0.88, and positive predictive value of 0.39. CONCLUSIONS: A large proportion of individuals with CKD are going unrecognized in the hospital setting. Automatic laboratory reporting of GFR and education about CKD may help increase awareness in both the inpatient settings.